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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I arct performing work on a property I own or occupy. <br />I 8fT~ a re?istered bulido( OR the authorized rep esen ave <br />of 8 re~btered builder, <br />The work will be pedormed by a registered builder. <br />Otller ...... <br />I have road and agree to the terms stated on the reverse side of <br />this documenL <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br />ow~'.f'E: 08/27/90 T J~IE: 18: t 7: 12 <br /> <br /> RU~ELL. Wl LBURN <br />SfTUS ADDRESS; <br /> <br />TAX LOT: <br /> <br />CONSTRUCTION TYPE: <br /> <br />75060-090 <br /> <br />RESIDENTIAL <br /> <br /> ?731 'FERRANCE LANE SE <br />AUr4SViLLE OR 9?325 <br /> <br /> CONTRACT CITY: UGBI <br />¢flAR I (.,W COUNTY NO <br /> <br />2130 COLE ROS <br />SALEM OR 9?306 <br />PHONE: 370-g107 <br /> <br />LOT: tCLOC K: <br />13'/' <br /> <br />SUBDIVISION: <br /> <br />TERP-.ANCESUBDiVi~ON <br /> <br /> $i1'E NUMBER: <br /> VALUA'fiON: <br /> <br /> 26 8~ 2W <br />234 i 52055. SF NO <br /> <br /> 8645 <br /> <br />ZONE: <br /> <br /> AR <br />CORNER: <br /> <br /> NO <br /> <br />MAP: <br /> <br />51 <br /> <br />'i'YPE: ON-SITE SEWAGE <br /> <br />PERNi'I' OR APPLICATION NO: <br /> <br />OhDNTRACI'OR, NO. 44551 <br />OWAiN BETHEL ~ SONS <br />P.O. BOX 504 <br />TURNER OR 9739~ <br />PHONE; 743-2~43 <br /> <br />26555 <br /> <br />~AI'ER SUPPLY: <br />'rE~'r HOLE~ READYt <br />sire EVALUATION NUC4BER: 19897 <br />EXISTING 'f'.,4WK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />8EP'f'ZC 'rANK PU~PEO: <br />PREVIOUS NO. BED~: <br /> <br />iTEJ',I QUANTITY AI'eOtJN't' <br />FILTER 1 $300.00 <br /> <br />PAYEE: <br />RECEIVED BY: <br /> <br />TOTAL~ED FEES <br />PRE¥IOUS RECEIPTS <br />'{'Hi~ RECEIPT <br /> <br />¢300.00 <br />300.00 <br /> $0.00 <br /> <br />BALANCE OlJE $0.00 <br /> <br />RECEIPT NO: <br /> <br /> TYPE: CHECK <br />SEEATTACHED [YOCUMENT FOR RE(,,~JIREMENT5 OF ON-511'E SEWAGE <br /> <br />* THI~ 1S A VALID PER~IT * TH~ ~IT I~XPIRES 380 DAY~ FRO~ ITS i~oLIE DATE. IF <br />CONSTRUCTION FAIL~ TO NEET ALL REQUIRE~E~NT~oF STATE LAV~ANDI~AR/ON COUNTY BUiLDiNG AND <br />ZONIN~ORDINANCE~, THIS PEt~VlIT ~rlALLBECOME NULL ANDVOID. <br /> <br />REMARKS: SAND FILTER PERI'Il' R~3782 ZONING:DNEILLiNG.'.'S PERMiTI'ED <br />DONALD E. hIOOOLE¥. {~tARJON COUNTY BUILDING OFFiCiAL <br /> <br /> OFFICE COPY <br />FORM # MD 15-56 REV. 4/90 <br /> <br /> <br />